Top-up payments

Q&A:

What are top-up payments?

Top-up payments are voluntary financial contributions from patients for access to drugs, medical devices or health services not funded by the NHS. Previously patients were not allowed to top up their NHS care with privately funded drugs or treatments, however since 2008 patients have been allowed to pay for additional services or drugs without losing their NHS treatment.

What are the arguments for top-up payments?

Top-up payments provide an alternative to healthcare funding mechanisms such as private and social insurance, rationing and private care. Paying top-up fees also allow patients to access new and expensive drugs which are not available on the NHS, such as new cancer drugs.

What are the arguments against top-up payments?

Top-up payments would mean that a patient's access to services would be decided on their ability to pay rather than their clinical need, and that a two-tiered health service would be created, divided into those who can pay and those who cannot. It could also mean that patients who can pay receive treatment they may not necessarily need, whilst those who cannot pay will not receive much needed treatment.

The authors of the article argue that top-up payments (voluntary financial contributions from patients for access to drugs, medical devices or health services not funded by the NHS) are an alternative to other healthcare funding mechanisms (e.g., private insurance, rationing, private care). They suggest that top-up payments are a clinically and economically viable healthcare provision tool.

In an article triggered by the article - How patients could benefit from top-up payments (Health Services Journal: 12 July 2012) - the author argues that top up charges would mean that a patient’s access to services would be decided on their ability to pay rather than on clinical need, and that a two-tiered health service would be created.

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